|
|
|
|
|
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
Patients / Dental Bytes
Article
1 - Toothpastes
|
 |
 |
Want whiter, brighter teeth? One option for you may be "toothwhitening," a procedure estimated by the American Dental Association (ADA) to account for the bulk of the 60 million cosmetic dental procedures performed in this country. Below is an explanation of this increasingly popular procedure:
Q. What Is Toothwhitening?
A. Teeth cannot actually be "whitened" using currently available
technology. Teeth can only be "lightened" meaning that the color
of some tooth stains can be changed from a yellow brown substance to a
clear color. This process uses a mild form of peroxide (carbamide peroxide)
to lighten discolorations of enamel and dentin. "Toothwhitening"
systems dispensed by dentists use a custom-fitted appliance that is worn
over your teeth during the day or while you sleep to hold the peroxide
solution on your teeth. The custom-fitted tray is hardly visible and does
not interfere with speech.
Q. What Causes
Tooth Discoloration?
A. There are many causes. It is most commonly caused by a lifetime
of consumption of staining substances (coffee, tea, colas, tobacco, etc…),
Tooth discoloration can also be caused by trauma, certain antibiotics,
excessive fluoride, old restorations and thinning of the tooth enamel.
Q. Who Can Benefit
From Toothwhitening?
A. The toothwhitening systems work best in patients that have healthy,
unrestored teeth and in patients that have moderate expectations. It is
important to understand that NOT all stains can be lightened; typically
only "organic" stains are susceptible to peroxide bleaching.
Not everyone's teeth will "whiten" the same. Yellowish-hued
teeth will probably bleach well, brownish-colored teeth will bleach less
well and grayish-hued teeth may not bleach well at all. Your dentist can
evaluate your situation and give you the best advice.. If you aren't a
good candidate for bleaching there are other cosmetic procedures that
can be employed to meet your expectations.
Q. Is Tooth Whitening
Safe?
A. The American Dental Association says that if you are going to get
your teeth whitened, you should do so under a dentist's supervision. Research
has indicated that whitening teeth with a 10% carbamide peroxide product
is safe for the teeth and gums under the supervision of a dentist. The
custom-fitted trays isolate the solution to the part of the teeth that
need to be bleached and keeps contact with the gum tissues to a minimum.
The Food and Drug Administration (FDA) thus far has not taken an official
stand on the regulation of whitening products. The FDA, however, does
agree with the ADA that consumers who are considering over-the-counter
whitening products consult with their dentist first.
Q. What About
Over-The-Counter Toothwhiteners?
A. Over-the-counter, at-home whiteners are not recommended. They often
can allow more exposure of the mouth tissues to the active whitening agent,
a situation that the ADA and scientists warn against. Dr. Kenneth Burrell,
director, ADA Council on Scientific Affairs says that "There are
some data to suggest that over-the-counter bleaching products may cause
damage to the tooth pulp, enamel, gums and other areas of the mouth. Only
your dentist first can tell you if any whitening procedure at all is appropriate
for you. He or she also can monitor the procedure and determine if any
adverse reactions do occur."
Q. How Does It
Work?
A. A bleaching solution containing carbamide peroxide is placed in
a thin custom-fitted tray that fits over your teeth. Your saliva and ambient
light break down the active ingredient into water molecules and oxygen
ions. These oxygen ions enter the enamel and dentin and change the molecular
structure of stain molecules. Many of the colored stains become clear
and your teeth appear lighter and brighter. It is important to note that
the stain molecules are not removed, rather their color is changed. The
structure of the tooth enamel or dentin is not altered in any harmful
way.
Q. How Long Does
It Take?
A. Some results are usually seen in three to seven days. Maximum results
generally occur when the process is continued for 14 days or more. Your
dentist will determine the appropriate length of time that you will use
this procedure, but it is typically no more than 2 weeks.
Q. Are There Any
Side Effects?
A. Some people experience increased tooth sensitivity to cold during
the treatment. Others have reported temporary discomfort, such as gum
or tooth sensitivity. These symptoms always disappear within 3-7 days
after interruption or completion of the treatment.
Q. How Long Will
The Results Last?
A. Your teeth will remain lighter for many months and even years,
depending on your diet and other environmental factors. At some point
you may desire a periodic re-bleaching or "touch-up" treatment.
These typically consist of a seven day treatment course every six to twelve
months.
Q. What is the
Role of Whitening Toothpastes?
A. Whitening toothpastes do not have the same ingredients as dentist-prescribed
toothwhitening systems. Nor do these products operate under the same environmental
conditions. They are applied to teeth for a relatively short period of
time and are not isolated from the diluting effect of saliva. As a result,
whitening toothpastes have little or no ability to lighten the stains
on and in your teeth. However, whitening toothpastes do contain ingredients
that actually remove some surface stains and give your teeth a highly
polished appearance. Therefore although you will notice very little effect
by using a whitening toothpaste on its own, they are very effective at
working to make your smile as bright as possible after a professional
toothwhitening procedure has been accomplished.
Q. What About
In-Office Bleaching Procedures?
A. Your teeth can be whitened right in the dentist's chair utilizing
a special heat or light source. Rapid results are possible due to the
efficient break down of the peroxide into its components, particularly
the oxygen ion responsible for the whitening process. While this procedure
is more costly, it generally produces results in one to two visits.
Q. How Do I Get
Whiter Teeth?
A. We can only "lighten" teeth, not whiten them. To truly
whiten teeth, crowns or veneers are necessary.
There are two classes of lightening products:
1. Over the counter products are really very fine polishing agents. The
teeth become shinier and then reflect more light. This makes the teeth
look whiter. (There is no peroxide in "whitening" toothpastes)
2. Prescription products
contain carbamide peroxide, which breaks down to hydrogen peroxide (H202)*
in the presence of light and moisture from saliva. H202 then breaks down
into water and something called oxygen free radicals in the presence of
moisture and salivary enzymes. Oxygen free radicals penetrate the surface
of enamel and combine with stain molecules. Carbon double bonds are broken
and the stain molecule changes from a colored substance to a clear one.
Yellow and brown stains change easier than gray. Fillings and crowns are
not affected.
*Remember, this is NOT the kind of peroxide that is in your medicine cabinet.
The bottled peroxide from the drug store SHOULD NOT be used in your mouth!
Q. How long have
tooth lightening products been available?
A. You could have brightened your teeth in the 1400's with honey and
burnt salt. We've come a long way since then from chlorine dioxide in
the 1860's through hydrogen dioxide, peroxide, sodium perborate ("walking
bleach") home bleaching and now vital tooth bleaching kits and laser
bleaching.
Home bleaching came
about through an accident. An orthodontist put glyoxide into a mouth tray
to improve the health of a patient's gums. The bad part was the gums got
worse; the good news was the teeth got lighter!
Q. I understand that there are many kinds of toothpastes around. How
do I choose?
A. There are actually 8, yes EIGHT types of toothpaste on the market.
All toothpastes consist of water, abrasives (scratchy stuff), humectants
(to make the toothpaste shiny), surfactants (to make the product foamy),
thickeners (so it doesn't fall off your toothbrush), color (to be more
interesting), flavor (so you'll use it), and an active ingredient (depending
on what it is really for)
The 8 categories
are or are for:
Caries control (to help prevent decay, or, as non-dental
folks say, "cavities")
Whitening
Gingivitis control (to help prevent gum disease)
Sensitivity (for teeth that hurt when hot or cold substances
are in the mouth)
Smokers (for teeth that are stained by tobacco)
Baking soda and peroxide
Tartar control (to prevent the hard deposits called "calculus"
by dental professionals)
Remineralization (to make the teeth harder)
Caries
control: (sodium fluoride vs monofluorophosphate)
The American Dental Association (ADA) (1994) stated the equivalency of
these two ingredients is usually seen at a concentration of 1100 parts
per million (ppm). In prescription form, a much higher concentration is
available (5000 ppm). This formula is generally recommended for patients
who experience a high rate of decay or are undergoing radiation therapy
in the region of the mouth.
The caries control toothpaste was developed in the 60's with "Fluoristat"
(stannous fluoride) which was not particularly effective. The change to
MFP/sodium fluoride in 1970-80's decreased decay WORLDWIDE by 50%. Consumers
should shop for toothpastes that contain the American Dental Association's
(ADA) seal of approval. Just because a toothpaste contains fluoride
does not mean that the toothpaste will prevent decay.
Whitening: Most whitening toothpastes do not contain peroxide. They do contain a superfine abrasive system and/or other polishing molecules like carnuba wax (do NOT use car wax on your teeth - YUCH!) to achieve a highly polished enamel appearance. Whitening toothpaste is less abrasive than regular toothpaste. The best use of whitening toothpaste is as a maintenance product after a person has had a professional cleaning and/or after professional whitening. There are over- the-counter products that are not technically toothpaste, but do contain a form of peroxide. These should only be used for a limited period of time.
Gingivitis control: The only ingredient approved by the ADA for the prevention of gingivitis is call "triclosan." Triclosan is found in household antibacterial agents such as soaps, detergents, etc. In toothpastes, it is in a much lower concentration with a special co-polymer which is necessary to bind the triclosan to the oral soft tissues. This prevents the agent from being washed away by fluids such as water, beverages or saliva. Triclosan is also an effective anti-tartar agent.
Sensitivity: There are three ingredients that help to control sensitivity. In order of least to most effective, they are stannous fluoride, strontium chloride and potassium nitrate. Most modern day toothpastes contain potassium nitrate. Stannous fluoride and strontium chloride work to block the "pores" in teeth that are known as dentinal tubules; potassium nitrate inhibits nerve activity. In the mid 90's the Food and Drug Administration allowed the oral pharmaceutical industry to combine two active ingredients in a single toothpaste. Sensitivity toothpaste is best used on a cotton swab held up on a dry tooth for 1 - 2 minutes. It can take 4 - 6 weeks for any effects to be noticed and the procedure must be continued for the patient's lifetime.
Smokers' toothpastes: Unlike whitening toothpastes, smokers' toothpastes have extra abrasive ingredients which are larger and "pointier" than the standard abrasives. These have the potential to dull the tooth surface and must be used on a limited basis. These toothpastes should not be considered a substitute for professional dental cleanings and polishings. Smoking cessation is the best method for preventing stain as well as for preserving overall health.
Baking soda and peroxide: Some dentists believe that the combination of baking soda and peroxide is healthy for gum tissues, although most modern practitioners do not believe this theory. The clean fresh feeling is misleading; the amounts of these ingredients that are found in toothpastes do not really have a therapeutic effect. In addition, the actual form of the ingredients does not produce the expected result. Baking soda does freshen both the breath and the refrigerator. Some products contain alcohol and should NOT be used by children or recovering alcoholics. Please read the labels carefully!
Tartar control: One of three ingredients is included in these toothpastes: pyrophosphate, zinc or triclosan. The most common ingredient is pyrophosphate. All these ingredients prevent the minerals in saliva from coming out of solution and bonding on to teeth to create plaque which hardens to become tartar or "calculus", the term that dental professionals use. These toothpastes DO NOT REMOVE tartar from teeth and do not prevent tartar from building up below the gum line. (Tartar below the gumline, "subgingival" causes periodontal disease) Tartar control toothpaste is not a substitute for professional dental cleanings. Only professionals can remove tartar below the gumline. Some people have allergies to pyrophosphate which can be seen when gums burn or peel.
Remineralization: This is the newest category on the market; therefore long-term clinical trials do not exist. Most information is from laboratory studies. The idea is that people who get cavities do not have enough minerals, such as calcium and phosphorus. Remineralization toothpaste has high levels of calcium, phosphorus and magnesium to compensate for the shortage. The interesting tube design keeps the ions, which are of opposite charges, separated. The theory behind the products is that tooth structure will become harder; the product does not contain enamel itself.
The above articles
were contributed by Dr. Martin Giniger, formerly of the Department of
Oral Pathology, Biology and Diagnostic Sciences. Dr. Giniger is an academician,
clinical dentist, holds a PhD in Biochemistry and has worked for an oral
pharmaceuticals company. He is an internationally recognized authority
on toothpaste and bleaching techniques with numerous articles published
on these subjects.
|
||||||||||||
